Senior Equity Research Analysts - Property/CleanTech/FIG/Technology Our client is a major small/mid cap focused investment banking group looking to find 4 additional experienced equity analysts.

Trading Analyst - Transaction Cost Analysis This job is based in Bermuda

]]> http://nursejobslondon.com/trading-analyst-transaction-cost-analysis/2537/feed/ http://nursejobslondon.com/jobsacuk-currently-has-518-jobs-in-this-category/2536/ http://nursejobslondon.com/jobsacuk-currently-has-518-jobs-in-this-category/2536/#comments Fri, 12 Mar 2010 12:15:02 +0000 admin SHIIIIIIIIIIIIT!!!!!!!!!!!!!!!
Everybody in nursing knows that in this business, shit is a way of life. Sometimes we put it more politely, but especially for those in critical care venues where techs are sometimes few and far between, it *is* a way of life. We are intimately familiar with excrement in all its permutations and can discuss it at length if called upon to do so. It’s also something we usually end up laughing inappropriately about.

In any case, last night was one of those nights. I had the same two patients as before, plus a new one who came in on day shift. All of them were total care but one of them could at least move some. It’s a good thing, too, because she was the one I was changing and cleaning up.every hour on the hour, it seemed! She’s maybe got a partial bowel obstruction, but there’s *something* going on there in any case.abdominal pain, nausea, and anorexia that’s not just from the cancer.
Then towards the end of the shift my patient who’d had the brain abscess was on the call light, and when I went into her room she said apologetically, “I think I’ve messed myself.” Boy, had she!
From her waist all the way to the foot of the bed!!! And she does not move well, so it took both of us (of course we had no tech) to clean her up. Thing is, there’s a gadget called a Flexi-seal, sort of like a Foley catheter for the other end, but it is only really effective for the liquid stuff, and people here are reluctant to use it. I’m not, but it’s a hassle to get an order. So, back to the cleanup.and cleanup.and cleanup. It’s a bad thing when you feel like you need a shower before your shift is half over!

Jobs.ac.uk currently has 533 jobs in this category Only the 20 most recent will be listed. Please see the Jobs.ac.uk web site for the latest job advertisements

Jobs.ac.uk currently has 518 jobs in this category Only the 20 most recent will be listed. Please see the Jobs.ac.uk web site for the latest job advertisements

]]> http://nursejobslondon.com/jobsacuk-currently-has-518-jobs-in-this-category/2536/feed/ http://nursejobslondon.com/experienced-sector-analyst-food-producers/2535/ http://nursejobslondon.com/experienced-sector-analyst-food-producers/2535/#comments Fri, 12 Mar 2010 06:08:10 +0000 admin Experienced Sector Analyst - Food Producers
London-based

Quality of life For awhile there I thought I was going to have the kind of patients that didn’t give me much to talk about.a smorgasbord of cardiac arrhythmias in patients who could pretty much do for themselves, just needed some tuning up with drugs. Then last week I got a guy who was pretty much of a train wreck, history of head, neck, and bladder cancer but with acute problems having little to do with those.septic as hell, with an apparent intra-abdominal abscess that was draining bunches of gunk, and a rapidly dropping blood count that may or may not have had anything to do with it. The night I got him I was basically stuck in the room all night, giving blood and platelets just as fast as I could decently run them, trying to hydrate him enough without filling up his lungs, and eventually attending to the (ick) drainage from where the abscess had been opened up. The next night was more of the same, without the blood transfusions, but with a couple of patients added.a new onset diabetic with some seriously weird family dynamics and a post-op laparoscopy who’d had some arrythmias the night before but was fine for me except for having to get up to pee about every hour on the hour, a process requiring something like an expeditionary force to accomplish. That was an exceptionally busy couple of nights! I was thankful for the 4 nights off I had taken for a birthday holiday. So this week it’s back to work, and my first night back I picked up a new admit. It seems that the Short Stay unit is pioneering a rapid admissions model, but I hope this patient wasn’t indicative of what they’re going to do, because they didn’t do much of any of the admitting process. That would have been bad enough, but my unit had only 2 nurses for the patients they had, and she made #7.and there was no tech. Needless to say, nobody was very happy. The patient is a 62 year old female with cancer who’s been in either the hospital or rehab since March. She looks far older than her stated age and has already made herself a DNR. At this point she was just sick, diagnosed with pneumonia and a heart rate in the 140s. She was on an amiodarone drip and it didn’t seem to be working all that well. She was also on antibiotics even though her white count was only 6.6, not indicative of bacterial pneumonia (hello, antibiotic resistant bugs!) and basically felt like hell. She just wanted to be left alone. A couple of other rather unremarkable patients kept me at least somewhat busy. Last night I came back to find she was still there and I also had another patient who was a total train wreck. This one had been in NeuroVascular ICU since January! She’s an old (1999) heart transplant and dialysis patient who showed up on New Year’s Day with altered mental status and seizures. Her course had been one horror after another.brain abscess, craniotomy to drain that, prolonged time on the vent with failure to wean, which led to a trach, blood clots which meant she got a filter to deal with that, PEG tube with feedings which she sometimes did not tolerate, just one thing after another. She came to us on the one day I had off before I started this weekend. And guess which one is NOT a DNR? Last night she refused her 4 am feeding, did not want a bath, and only wanted the bare minimum of care. Well, if I’d been in ICU for 7 months, I wouldn’t want to be messed with either! When you’re in there, someone is always doing *something* to you, there are lights on most of the time, and the noise level can be pretty hideous, if not your alarms, the ones in the next room.who wouldn’t want nights of dark and quiet and minimal messing-with? I personally think baths on night shift are pretty barbaric unless the patient doesn’t really know what time it, and both my ladies were alert and oriented x3 and well within their rights to refuse a 5 am bath. All this only strengthens my resolve that I will NOT be that kind of patient. I do not want to be in the hospital having things done to me if my outlook is that bleak and I have no better quality of life than these ladies. Of course I don’t want prolonged dialysis either. It’s a tossup whether dialysis or a trach would be worse, but I guess it would depend on how well I could get around. In point of fact, I don’t want either. Just give me my pain meds, leave me alone, and let me go wherever it is I’m going. Thank you very much.

settling in and other oddments I’m now about halfway through my orientation period and feeling pretty good about it. I’ve been taking the patients on the team, leaving my preceptor (usually the charge nurse) free to help out wherever.the other night she was about to fall asleep so she volunteered to be our tech for the night, since our real tech had been pulled. (This is more usual than not, and I’ll discuss that later, or maybe another time.) So now I take up to three patients, depending on our census, and do admissions with all the attendant paperwork, and draw labs, and enter orders, and all the usual stuff the night shift does. Our patients are not quite as critical as advertised, for the most part, but occasionally we’ll have one who’s pretty sick. Actually our sickest patient is chronic, and if she could get stable enough she really belongs in skilled care or maybe even rehab. She was in a horrible MVA last year sometime and she’s lucky to be alive, if you can call her current status living. She must have been in a bad T-bone crash; everything on the left side of her body was smashed. She was on the vent for an unconscionable amount of time and still has her trach. Had a PEG tube too when she arrived, but no longer does. An external fixator on her left humerus. Foley, of course. And naturally, decubiti from hell, including one I could probably lose my fist in. There’s a total of six dressings, but only two of them fall to my shift, being twice a day. The first time I did them it took me an hour. I’ve gotten faster and learned to combine the dressing changes with her bath, which means she gets cleaned up at an unearthly hour, but I’m not real sure she knows what time it is since she’s been in the hospital for so long. I suspect she also has a traumatic brain injury–how can you get that much of you smashed and not have one?–although some think she has ICU psychosis. Well, why not both? Anyway, after an initial period of circling each other cautiously, we seem to have come to a point of actually liking each other. At least she usually smiles at me when I come in, and I’m beginning to think we have similar senses of humor. One night when I had finished the worst of her dressings and rolled her back onto her back preparatory to doing the other, she looked at me and said “I need a drink!” I said “So do I!” and we both laughed fit to kill. She gave the nurses hell on Thursday, but when I came back Friday she seemed glad to see me. That does kind of make me feel good. My apartment is sort of stuck right now until I can get some paycheck into it, so it looks like I’m still moving in. I think once I get my queen mattress in and can move into the master bedroom the puzzle will unlock. I’ve started on my garden, gotten it tilled at least, but lately it’s rained almost every day I’ve had off, and I can’t get the raised beds built, so all my plants are sitting in their containers on the patio. When I do manage to get it in, I’ll have tomatoes and peppers, green beans, greens, radishes, beets, cucumbers, eggplant.and sunflowers! And now for a non-nursing note.this morning I got up and as usual while having my coffee perused various news sites from places I used to call home. Imagine my surprise when I saw this picture on both the local paper of my former home town AND a tv station website! The occasion was the dedication of a new veterans’ memorial for Iraq vets, of which my son is one. He’s the skinny guy on the right front of the pic. His name doesn’t get mentioned in the article, but I knew he was working on the project. It’s just like him to do the backstage work and let someone else do the talking (the husky dude on the left front, who is his best buddy in the guards). He can’t help being so photogenic! Am I proud of him? You bet.but I wish he hadn’t had to go, that one of the guys he worked with hadn’t encountered a roadside bomb and been permanently disabled, and that so many hadn’t been killed and wounded. Now his outfit is on alert again.dammit, somebody stop this insanity!!! Anyway, here he is, my pride and joy.

]]> http://nursejobslondon.com/experienced-sector-analyst-food-producers/2535/feed/ http://nursejobslondon.com/to-travel-againor-not/2534/ http://nursejobslondon.com/to-travel-againor-not/2534/#comments Fri, 12 Mar 2010 00:33:02 +0000 admin Remote Gambling Project Manager - KTP Associate
Enterprise and Development - University of Salford / Date of entry: 06/03/10

Jilly settles down at last I debated whether to end this journal entirely, or just change the title. I couldn’t see just leaving it here and going somewhere else, and I didn’t want to start a whole new one here, so.why not just change the title? I’ve been here in Capital City for two weeks, and it seems like I’ve been here forever. Part of it is that I was here as a traveler a couple of years back, and I’m living in the same part of town I lived in then, only south of the main drag instead of north. I know pretty much where everything is, what supermarkets are where, and (very important!) where Wal-Mart is. I wasn’t as familiar with this side of the main drag, so I was delighted to find things like a neighborhood Indian restaurant and grocery store right up the street. I know where the libraries are and have decided I like the older branch better than the new one. I’ve found the post office. And best of all, my new apartment is just over a mile from the hospital. My apartment is in a townhouse community and is spacious and quiet. I wanted a townhouse because I’m tired of people stomping around overhead and didn’t want to live on a third floor somewhere. I’d actually been looking at another complex, but when I found this one I knew it was right. It’s not a huge community, and though there are quite a few kids, it’s not overrun and they seem to be well-behaved. I couldn’t imagine living in an adults-only community! Downstairs I have a kitchen, dining area, and sunken living room with a *working* fireplace. Upstairs are two bedrooms and two bathrooms. I have a private patio and even a small garden plot (and yes, I do plan a tiny kitchen garden!) as well as a small area out front where I can plant flowers. OK, the hospital. It’s HCA, which has its pluses and minuses as they all do. Decent benefits and retirement plan, pretty reasonable working conditions, and this particular one has an excellent reputation. The minuses are an antiquated computer charting system which I am already familiar with from other HCA hospitals, and maybe not the most up-to-date equipment. But everyone has been very positive and very welcoming. Probably the only place I’ve felt that welcomed was the one where I was last summer. I’ve done my mandatory week of nursing orientation and Sunday night I start actually working. Amazingly, they’re not making me orient on days for a week either; I start right in on nights. I never could figure out why most places make you do day shift orientation first; it’s a completely different animal from nights. One excuse sometimes given is “so you get to know the docs” but you don’t see much of them during the day because you’re busy running yourself to death. But then you have to learn a whole new routine when you go on nights, and that loses you another week. I’m delighted someone has actually seen the light!

To travel again.or not? Well, I’ve been back here for a couple of weeks now. It’s a relief to be away from that horrible hospital, and I now see it’s a relief to be away from that agency as well. Things I have learned recently tell me it’s a second-rate one, and I wonder that I was gullible enough to work for them in the first place. Well, in the balance my first experience with them wasn’t THAT bad; River City was interesting and I learned a lot. But this one.yikes! And what I learned from talking to other nurses there and on the forums has made me quite glad not to be dealing with them anny more. So now I’m trying to decide whether I want to take a permanent job someplace or keep on traveling. Both have their charms. Traveling is good because I know it’s only 13 weeks if I don’t like it, but the downside is that I feel rootless much of the time. I would love to have a place of my own and be settled somewhere, but I’m not sure I want to be embroiled in hospital politics any more. I’ve toyed with the idea of moving to Capital City whether I actually get a job there or travel from there. Ideally I would find a travel position within 3 hours driving distance, get my schedule “blocked” (set up so that I work all 36 hours within 3 days) and come back home when I’m off. So, to that end, I’ve applied for a number of jobs, but I’ve only actually had an interview with one of them. That was at the hospital I worked at as a traveler in Capital City, but in the (mostly autonomous) heart hospital there. And I didn’t get to talk to the manager, only the HR guy, who asked me some very good questions. But that was last Thursday, and I have yet to hear from anyone. I am dubious that anything will come of this. Back to the drawing board *sigh* In any case, I can’t go anywhere until after the middle of February when I will welcome my new grandson into the world. He is a long-awaited blessing for my daughter and her beloved, and quite possibly the last grandchild I will have. I’m not missing his arrival! After that, who knows? Back to filling out applications and sending out resumes.

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]]> http://nursejobslondon.com/to-travel-againor-not/2534/feed/ http://nursejobslondon.com/equity-analyst-investment-management/2533/ http://nursejobslondon.com/equity-analyst-investment-management/2533/#comments Thu, 11 Mar 2010 18:07:03 +0000 admin picking up the pieces
I haven’t posted in over two weeks, bad on my part. I think I was so shell-shocked a couple of Sundays ago that it’s taken me this long to recover. That night was INSANE.we had 9!!!!!! admissions. That in itself would have been bad enough, but ER here is prone to sending them up in batches, and at one point we got 4 literally at once. It was so bad that at one point there was actually a traffic jam at my end of the hall, with two stretchers, patients aboard, trying to go in opposite directions, neither willing to yield the right of way. When it was getting on toward morning, the charge nurse stopped by and asked if I was going to be able to finish up by time to leave. I said I thought so, although I couldn’t possibly figure out what I had done and what I had left undone. She just rolled her eyes and said, “I know.and I don’t know what I *don’t* know any more!”

As if that wasn’t enough, the patients I already had were very needy. One in particular, I shall call her Ms. S, who had end stage COPD (emphysema kind of stuff, for any non-medical types). I felt genuinely sorry for her in a lot of ways; she’d had breast cancer a few years back, and according to her, the chemo and radiation had basically caused her body to completely fall apart. The problem I had with her wasn’t going into her room, it was getting OUT. It just seemed there was always something *else* she needed, and she was in love with her call light.

Last weekend wasn’t nearly as bad.busy, but steady-busy, not insane-busy, at least for me. As the day nurse I traded off with said, “You couldn’t hand pick a better team.” There were the two guys I thought of as the Twin Tummies, with the same diagnosis, symptoms, and meds, just that one was 20 years older than the other and just a bit sicker. There was the lady with the mystery diagnosis, and I wonder if they ever figured out what it was. And then there were the assorted wheezers and coughers. But they were all nice, and nobody was crazy, more than I could say for some of the others.

One of my friends had Ms. S on Friday night and reported that she was going down fast. The lady had been a DNR but had rescinded it, much to the consternation of the nurses who saw which way things were going. I could sort of understand it.the lady wanted to go her own way, kicking and screaming.but she didn’t have much to work with, and we all knew that. Sometimes you’ll hear nurses say, “I’ll WALK to that code,” but when it comes right down to it we’re going to try just as hard to save that life as any other. And that’s what happened to Ms. S. Sometime on Saturday she went abruptly down the tubes and ended up in ICU with tubes down her. Around 2:30 Sunday morning a bunch of us were standing around the nurses’ station when “code blue, ICU B” was called overhead. We all looked at each other and more or less simultaneously said, “I wonder if that’s Ms. S?” It was, of course. Later on, at shift change, we heard that she actually coded three times and her husband made her a DNR again. As of then she was still hanging on, but she went later in the day. (I hope you found peace, Ms. S)

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Post Doctoral Research Associate Beamline I18 Diamond Light Source / Date of entry: 05/03/10

]]> http://nursejobslondon.com/equity-analyst-investment-management/2533/feed/ http://nursejobslondon.com/fubar/2532/ http://nursejobslondon.com/fubar/2532/#comments Thu, 11 Mar 2010 12:27:02 +0000 admin Senior Research Nurse
Centre for Tumour Biology - Institute of Cancer - Barts and The London / Date of entry: 06/03/10

FUBAR! Well, here I am in Up the Road. It’s been two days of the most completely surreal, disorganized, and poorly managed orientation I have ever lived through. I keep telling myself that it has to get better, and that a bad dress rehearsal means a good performance. I hope to hell that’s true. I arrived on Sunday afternoon, and as usual, I got lost and wandered about for awhile before I found where I was supposed to stay until my apartment was ready. Part of that was Google’s fault for making their maps and directions more convoluted and backwards than usual. By the time I got there I was feeling completely horrid; somehow, while loading my car, I’d managed to get myself a pretty good back spasm. So I thought, anyway. I’d been told to go over to the hospital staffing office and ask for the traveler packet, so I dutifully did so, even though I was feeling worse by the minute, only to be told “We don’t have any. They haven’t been giving them to us to give you.” Well, that was useless, I thought, and dragged myself back to my car. By this time I hurt everywhere, not only my back, but all over, with a pounding headache and a spaced-out feeling I couldn’t figure out. I realized I hadn’t had anything much to eat all day, so I thought I’d run over to Wal-Mart, right across the street from the hotel, grab something, and go back and hole up in my room. Which is exactly what I did. When I got back there it suddenly occurred to me what my problem was; I’d had my flu shot on Friday and was having the first and only reaction I’d ever had to one. So I medicated myself, ate, and wrapped up in a blanket for the rest of the evening, feeling nothing short of hideous. Monday morning I got up feeling mostly okay, just a little tired. I went to the hospital as instructed, expecting to meet the person billing herself as “nurse recruiter” in HR. Instead, I was directed back to the staffing office, where a couple of bewildered schedulers were with three equally bewildered travelers. After some frantic phone calls, it was finally decided that we should go to the HR office, which is in a huge shopping center about 3 miles from the hospital. We were given directions (which turned out to be largely bogus) and all piled into one nurse’s van. When we got to the office, the lights were on but the door was locked and no one was there. We stood outside in the dark and cold trying to figure out what to do, until finally one of us took charge and started making phone calls.and getting voicemails! Eventually she managed to get hold of someone in administration, who informed us we were supposed to be back at the hospital in HR!!! So we piled back into the van and went back to the hospital, laughing because it beat being angry, and eventually managed to find the HR office and the “nurse recruiter,” who turned out to be an uppity blonde 20-something with major attitude. Her first words to us were, “You’re late!” We know, we said, attempting to explain what had happened, but she didn’t seem to want to hear it. We had obviously messed up her agenda and she was going to let us know about it. She took pictures for our badges and sent us to the education center around the corner. At last we were where we were supposed to be! We got started with the innumerable tests that every hospital demands–OSHA, HIPAA, safety, patient rights, pharmacology, etc. etc.–only to be interrupted by another blonde 20-something, this one pleasant and earnest, who wanted to know what had happened earlier and who had sent not only us, but at least half of the other orientees, to the wrong places. She took copious notes and promised us “things will get straightened out.” And the screwups continued. At lunchtime, three of our little group climbed into someone’s car and headed for the place we’d been told to go to for our drug screen.to which, it turned out, we had been given more bogus directions! But we found it, duly peed in cups, and headed on back, swooping into KFC for a snack before the afternoon’s LOOOOOOOOONG computer learning session, on a program I’ve used before. (To be continued)

Research Fellowship Thermodynamic Modelling of Metallic Materials - BCAST (Brunel Centre for Advanced Solidification Technology) - Brunel University / Date of entry: 06/03/10

the weekend, part 2: out of 5 I meant to finish last weekend off earlier, but here it is time for this one and I haven’t yet! So this will be a quick post. Sunday night can best be summed up as “x out of 5″.as in: 3 out of 5 of my patients were DNR; 2 of 5 even knew who or where they were; 4 out of 5 were incontinent of poop, and that’s where my night went. The patient admitted toward the end of the shift Saturday morning was still lingering, now on comfort measures only, with family sitting quietly in the room. I watched, fascinated, as her O2 saturation dipped to 71% and then 64%, though there wasn’t much change in her other vital signs. Surely she couldn’t last the night with that.but she was still there when I left. My lady from the nursing home Friday night was doing pretty well, responding to antibiotics, confused but pleasantly so, and thus no trouble at all. Then there was the other DNR, confused beyond belief, well-known to be a wanderer, and massively and odoriferously incontinent.multiple times. Compared to him, the dialysis patient next door, also incontinent, was nothing, because at least she didn’t holler and fight you when you were cleaning her up. And the guy who wanted his pain meds? Nothing to it, except that the docs were supposed to have changed him to oral meds so they could send him home Monday. (Guys? He can’t go home on IV Dilaudid for this problem!) So that was my night.mass (mess?) confusion and cleanup. It could best be summed up by the occurrence at the end of it all when I was totally punchy. I was in with the aide cleaning up Mr. Stinky yet again. I was holding him rolled over towards me when he ripped a huge one. “That does it!” said the aide. “Next time I have to fart, I’m coming in HERE and doing it!” I couldn’t help it. I lost it completely and we finished up both giggling like idiots.

]]> http://nursejobslondon.com/fubar/2532/feed/ http://nursejobslondon.com/i-hate-it-here/2531/ http://nursejobslondon.com/i-hate-it-here/2531/#comments Thu, 11 Mar 2010 06:19:09 +0000 admin Pathology Museum Attendant
Cellular and Molecular Medicine - St Georges University of London / Date of entry: 06/03/10

I hate it here! Yep, that’s right. I hate it. I don’t like the hospital or the city. I like the people I work with okay, and the unit is very nice, but I don’t like it. There are things going on that I don’t understand and they make me uncomfortable. Staffing over most of the hospital sucks. There is no phlebotomy, so nurses have to do their own lab draws (actually, the patient care techs can do them, but they can’t draw from IV lines, so it falls on the nurses much of the time anyway). On nights there is no clerical staff, so all of that has to be done by the nurses too, unless the techs happen to have clerical training and the time to use it. On my unit, it’s quite a bit the opposite. Most nights there are three nurses, but rarely do we have more than 6 patients, not that I’m complaining about THAT; I just wonder how long it will be allowed to go on. Now some of the nurses who have been out sick or having surgery are returning, and on many nights there will be even more of us. To me this suggests one thing.floating. Now, I don’t mind floating *on occasion*, so long as I’m being floated to some area in which I’m reasonably competent, but the word I am getting is that travelers float first, and I’ll be damned if I’m coming in every shift to go somewhere else. If I wanted to be in float pool I’d have signed on for it! And.last week the manager who hired me was fired. I still don’t understand the mechanics of that, but it scares the hell out of me. When I first got here I heard rumors of some kind of screaming match between one of the nurses and the secretary who had been doing the schedule, resulting in a communique that all schedule requests and changes were to go through the manager or her superior, a person of whose existence I had been previously unaware. A week or so later, I heard that the manager had resigned. The word was that she was going to cath lab at another hospital in the system. Thursday she stopped by the unit to let the day shift know she’d been fired.from cath lab, from the whole hospital, and apparently from the whole system. Nobody really knows what happened, but apparently there’s going to be some serious uproar in HR. This morning our secretary was talking about some changes being made. She mentioned that probably most of the travelers would not be extended, but that didn’t particularly bother me, as I have NO intention of extending my contract. Neither do two of the other three who started when I did, and the other traveler, who’s been there for almost a year, had spoken of moving on. My concern is more in terms of my contract being canceled before it’s over. I can deal with that, I guess, if it happens after Christmas, but I need the money up until then. I’m starting to think about looking for a permanent job.

]]> http://nursejobslondon.com/i-hate-it-here/2531/feed/ http://nursejobslondon.com/experienced-trader-european-cash-desk/2530/ http://nursejobslondon.com/experienced-trader-european-cash-desk/2530/#comments Thu, 11 Mar 2010 00:34:01 +0000 admin Dividends analyst
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I think this post might be a mixed bag.part rant, part reflection, part I-don’t-know-what. I’d meant to post something a week or two ago about how you get to know people in the wee hours of the morning and somehow it never got written. As most critical care folks know, baths are primarily a night shift thing. I don’t necessarily agree with that, at least not in the case of folks who are alert and oriented and can do at least some things for themselves, and especially not if they want to SLEEP! But if they are wakeful, as many older folks are along about 4 or 5 in the morning, sometimes it’s a good time for a wash-up and a bed change. There’s something about the process of doing all this that invites conversation and recollection. I’ve always been one who likes to listen to stories, so maybe I’ll ask the patient a few questions, and often the stories just pour out. Maybe they’re tales often told but now to a new audience, or maybe the patient hasn’t had anyone to listen to them in some time. In recent months I’ve heard stories from a World War II bomber pilot, mostly about the base in England where he was stationed rather than about his missions.most veterans don’t want to talk about those in specifics.and from a man who was a medic in the Korean War. I’ve learned what it was like to be a very young bride just after WWII. I’ve delighted in the stories of a woman who was one of eight girls in a family of eleven children, and laughed with her about what it was like to line up to get your hair braided in the morning.(”You’d better have the knots combed out before you got to mama, and the bigger ones combed out the little ones’ hair.”) Everyone has a story, and I find myself making little notes of things I might want to remember if I ever stop doing other things long enough to sit down and write seriously. But I have to admit that I don’t like being *expected* to give those baths whether the patient wants it or not. Last night my partner and I had a couple of very “busy” patients. Hers was far busier than mine and far more sad, a woman dying of ovarian cancer, a retired nurse, sister of one of our docs, scared, in pain, disoriented because of some of her medications. I think she would like to let go but thinks maybe her family isn’t ready. She’s DNI–do not intubate–but not yet DNR. My thinking is that she might be ready for hospice, but I am not so sure about her family. Last night I sat with her for a few minutes while her nurse went to get something for her, and we talked about grandchildren, which seemed to divert her fears at least for a little. Stories. About my patient, I don’t know whether to be sad or very, very angry. He came from a nursing home, and the story is that he was essentially “dumped” in our ER from a handicapped van, emaciated, with a leaking, corroded, non-working feeding tube. (Those don’t get that way overnight, folks!) The feeding tube was replaced and the area cleaned up and he was sent up to us. Okay, so he has a history of alcoholism and smoking and respiratory failure and lung cancer (chemo and radiation), and he has a trach so he can’t make himself heard.but how did he get to his current state just since April? He told me he used to weigh 198 lbs; when he came to us he weighed 100. He looks like a damn concentration camp survivor! To me the damning evidence is the condition of the feeding tube when he was admitted. I know nursing homes are understaffed, and that so many of the workers are undertrained and overworked, and many are burned out, but surely *someone* should have noticed and referred him to the doctor. Did he just not get attention because he’s quieter than some of the other patients? He’s perfectly alert and oriented and can make himself understood if you just take the time to pay some attention. Did they keep pouring tube feeding formula into the tube and letting it go who knows where, or did they stop just feeding him because the tube wasn’t working? Who let it get this bad? It’s a pretty damning indictment of this particular nursing home, at least in my not-so-humble opinion. I don’t know what family he has, a sister I think but no one immediately available, so it seems there is no one to advocate for him. For now I just have to do what I can, manage his meds and his feedings, keep him turned and dry and clean, and hope to hell someone picks up the ball that got dropped. I need to remind myself to hunt up a clipboard for him tonight so he’ll have a surface he can write on when he wants to tell us something.

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Ultra-High-Freq Algo Quant - LondonMy client is a privately held ultra-high-freq trading firm who are seeking to hire profiles with strong implementation experience of sell side Algos

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